Dysphagia screening and pneumonia after subarachnoid hemorrhage: Findings from the Chinese stroke center alliance

Abstract

Background and Purpose Dysphagia is common and is associated with aspiration pneumonia. However, little is known about the prevalence of and factors influencing dysphagia screening (DS) and pneumonia after subarachnoid hemorrhage (SAH). Methods We used data on SAH patients admitted to 1476 hospitals from the China Stroke Center Alliance (CSCA) from August 2015 to July 2019 to analyze the rates of DS and pneumonia. We then conducted univariate and multivariable analyses to examine the relationship between DS and pneumonia. Results Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Compared with patients without pneumonia, patients with pneumonia were older (mean: 63.4 vs. 57.8 years of age), had lower Glasgow Coma Scale (GCS) scores at admission (mean: 13.5 vs. 14.3), were more likely to have dysphagia (15.2% vs. 3.3%), and were more likely to have undergone aneurysm isolation (19.1% vs. 10.0%). In multivariable analyses, factors independently associated with a higher risk of pneumonia were dysphagia [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.85–4.98], age (OR, 1.50 per 10‐year increase; 95% CI, 1.40–1.60), male sex (OR, 1.23; 95% CI, 1.02–1.49), arrival at the hospital by emergency medical services (OR, 1.36; 95% CI, 1.16–1.58), nimodipine treatment (OR, 1.42; 95% CI, 1.11–1.81), endovascular embolization of aneurysms (OR, 1.23; 95% CI, 1.03–1.47), cerebral ventricular shunt placement (OR, 2.24; 95% CI, 1.41–3.54), and treatment at a higher grade hospital (OR, 1.44; 95% CI, 1.21–1.71). Conclusion More than a quarter of patients with SAH did not have documented DS, while one‐fifth developed pneumonia. DS performance was associated with a lower risk of pneumonia. Randomized controlled trials may be needed to determine the effectiveness of DS.

Research trends and hotspots of post-stroke dysphagia rehabilitation: a bibliometric study and visualization analysis

“…The severity of PSD modifies the patient’s food patterns, and alterations in eating pathways increase the likelihood of respiratory infections ( 57 ). According to studies, more than a quarter of patients with subarachnoid hemorrhage are not evaluated for dysphagia, and one-fifth of these patients acquire pneumonia ( 58 ) and delays in dysphagia screening and evaluation increase the risk of pneumonia infection. As a consequence, detecting and treating dysphagia in stroke patients at an early stage can help minimize the risk of pneumonia and death ( 2 , 59 ).…”

Ventilator-associated pneumonia in critically ill patients with subarachnoid haemorrhage: single-centre experience

“…The higher incidence of pneumonia in the SAH patient population is favoured by sudden disturbances of consciousness [6]. Dysphagia, as a focal neurological symptom in SAH, can affect up to 75% of patients [14]. With delayed airway protection by endotracheal intubation, the risk of pathogen aspiration into the lower airway increases, but intubation and bronchoscopy alone also carry a risk of pathogen transmission from the upper airway [15].…”

Impact of Off-Hour Admission on In-Hospital Outcomes for Patients With Stroke Receiving Reperfusion Therapy in China

“…28,29 Additionally, prior studies have indicated that stroke-associated pneumonia is frequently attributed to aspiration and dysphagia, while an increased risk of pneumonia is associated with inadequate dysphagia screening performance. 30,31 Notably, staffing shortages during nighttime may result in reduced availability of dysphagia screening and swallow therapy services. Future research should also aim to clarify the impact of low nurse-to-patient ratios and nighttime admissions on adherence to dysphagia screening.…”